Affiliation:
1. Anatomical Pathology, Pathology Department, Faculty of Medicine, Cairo
University, Cairo, Egypt
2. Medical Biochemistry and Molecular Biology, Cancer Biology Department,
National Cancer Institute, Cairo University, Cairo, Egypt
Abstract
Abstract
Objective To evaluate the accuracy of thyroid imaging reporting and data
system (ACR-TIRADS) and the Bethesda system for reporting cytopathology (TBSRCP)
classifications for identifying or ruling out thyroid malignancy in relation to
the gold standard (post-surgical pathology).
Methods This cross-sectional study included 573 patients with single or
multiple thyroid nodules. Patients were evaluated using the TIRADS and the
TBSRCP classification. The data from a cohort of patients who underwent surgery
(77/573, 13.4%) were correlated with post-operative pathology and the relevant
clinical features of the patients.
Results Of 573 patients, 545 (95.1%) were euthyroid, 24 (4.1%) were
hypothyroid, and 4 (0.8%) were hyperthyroid; 419 (73.1%) had benign nodules
(Bethesda II), 115 (20.1%) had intermediate (Bethesda III, IV), and 39 (6.8%)
had Bethesda V and VI nodules. Four-hundred twenty (73.3%) patients were
categorized as TIRADS 2,3, and 153 (26.7%) were categorized as TIRADS 4,5. The
Bethesda and TIRADS classifications concorded significantly in thyroid nodule
diagnosis (K=14.9%, P<0.001).Thyroid malignancy was significantly associated with microcalcification and
interrupted halo, while benign nodules were significantly associated with
macrocalcification and complete halo type (P=0.041, P=0.005, respectively). The TBSRCP could significantly detect malignant thyroid nodules with a
sensitivity, specificity, PPV, and NPV of 64.1%, 98.1%, 85.0%, and 94.1%,
respectively (K=88.2%, P<0.001), while the respective values for the TIRADS
classification were 63.5%, 76.0%, 84.6%, and 50.0% (K=34.8%, P=0.001).
Conclusion The TIRADS and TBSRCP are essential primary steps for
evaluating thyroid nodules and both are complimentary. Hence, each patient with
thyroid nodules should be evaluated by both approaches before opting for
surgery. Highly suspicious TIRADS categories TR4 and TR5 need further evaluation
by fine needle aspiration cytology.